519 Clinical translation of quantitative ultrasound for nail disease: Bridging imaging biophysics and dermatology

Objectives/Goals: To translate quantitative ultrasound (QUS) from imaging biophysics into clinical dermatology by evaluating its reproducibility, diagnostic differentiation, and potential as a noninvasive, point-of-care tool for nail disease assessment. Methods/Study Population: Diagnosing nail disease is difficult due to overlapping features and the invasiveness of biopsy. In a prospective study (recruitment ongoing), patients with onychomycosis, inflammatory nail disease (psoriasis or lichen planus), and controls underwent 15-MHz ultrasound of fingernails and toenails (n = 26 patients, 152 nails). Raw radio-frequency data were processed to derive three QUS parameters: Homodyned-K α (microstructural organization), effective scatterer diameter (ESD) (scatterer size reflecting tissue texture), and effective acoustic concentration (EAC) (scatterer density reflecting compactness). Metrics were analyzed with t-tests and mixed-effects models. Within-patient consistency and parameter reproducibility were evaluated to assess clinical translation feasibility. Results/Anticipated Results: Diseased fingernails (33 vs 54 controls) showed reduced α (−1.11, p < 0.001), reflecting loss of microstructural organization. Onychomycosis had the largest change (−1.25), while inflammatory nails were moderately reduced (−0.93). ESD showed opposite trends (+0.85, p = 0.02) indicating coarser scatterers in fungal disease, and EAC was uniquely elevated in lichen planus (+1.30, p < 0.01), consistent with fibrotic regions. In the toenail cohort (16 diseased vs 49 controls), onychomycosis showed parallel changes (α −0.9, p < 0.001; ESD +1.0, p = 0.02), supporting reproducibility across nail sites. Findings were confirmed by mixed-effects models. Together, these parameters quantify disease-specific microstructure and demonstrate technical and biological feasibility for clinical translation. Discussion/Significance of Impact: QUS provides interpretable biophysical markers that differentiate fungal, inflammatory, and fibrotic nail diseases. By bridging imaging physics with clinical diagnosis, QUS offers a scalable, noninvasive approach for point-of-care dermatologic imaging and advances the translation of QUS into practice.